Medical Aspects of Chemical Warfare (2008) - The Black Vault

Medical Aspects of Chemical Warfareadministered via an autoinjector, to prevent and treatstatus epilepticus (Figure 21-3). Israel is moving towardusing midazolam for its population. Some physiciansrecommend using lorazepam in the pediatric population.Regardless of which medication is administered,repeated dosing may be needed. Benzodiazepinesshould be considered for the pediatric population ifseizure activity is suspected. However, nonconvulsivestatus epilepticus and subtle seizures are common ininfants and children, making it difficult for healthcareproviders to recognize these as signs of nerve agenttoxicity.Each of the medications used to treat nerve agenttoxicity recommend weight-based dosing for pediatricpatients (Tables 21-3 and 21-4). The exact dosing for aspecific patient depends on two factors: the severity ofthe exposure and the weight or age of the patient.Fig. 21-2. Antidote treatment nerve agent autoinjector (AT-NAA) and Duodote.Reproduced with permission from: Meridian Medical TechnologiesInc, Bristol, Tenn.or death. Subsequently, several pediatric guidelineshave suggested that adult-dose atropine and 2-PAMCl autoinjectors can be safely used in children largerthan 13 kg and inserted to 0.8 inches.Atropine and 2-PAM Cl must be administered cautiously.33 Atropine can cause increased heart rate anddry mouth and skin, and near vision can be affected forup to 1 day. It can also prevent sweating, so elevatedtemperatures and heat stress may be observed. 2-PAMCl can cause double or blurred vision and dizziness,and doses must be reduced with renal insufficiency.Laryngospasm and rigidity can occur if the medicationis given too quickly via IV. Higher doses can causehypertension, while lower doses can cause minorelectrocardiogram changes.Benzodiazepines are not considered antidotesto nerve agent poisoning; however, because statusepilepticus often occurs as nerve agent crosses theblood-brain barrier and causes irritation, they arethe only agents that have been proven to treat nerveagent–inducedseizures and should be used for bothprevention and treatment. 33 Benzodiazepines shouldbe quickly administered if consciousness or more thanone organ is impaired or if there is muscle twitching.The US military uses the benzodiazepine diazepam,Fig. 21-3. The diazepam autoinjector.Reproduced with permission from: Meridian Medical TechnologiesInc, Bristol, Tenn.664